Healthcare Provider Details

I. General information

NPI: 1013470780
Provider Name (Legal Business Name): TESSA'S THERAPIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 DE RODRIGUEZ LN.
SAN MIGUEL NM
88058
US

IV. Provider business mailing address

PO BOX 405
SAN MIGUEL NM
88058-0405
US

V. Phone/Fax

Practice location:
  • Phone: 575-644-9861
  • Fax:
Mailing address:
  • Phone: 575-644-9861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: THERESA ANNE ONTIVEROS
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 575-644-9861